Clips and applicator for tissue closure

ABSTRACT

Surgical clips and surgical applicators used in performing rapid tissue closure in either minimally invasive surgeries or traditional open procedures are provided. In one example approach, a surgical clip comprises opposing sides extending from a top portion and terminating at tips positioned below the top portion. The resting position of the clip is its closed position. Edges of the top portion and the opposing sides form opposing faces perpendicular to the opposing sides. The opposing faces are angled inwardly towards each other at a region of the faces adjacent to the top portion. Grooves are formed in each of the opposing sides. The grooves are configured to engage inwardly turned tracks of a clip applicator such that, when a force is applied to the clip, the opposing sides bend outwardly away from each other to place the clip in an intermediate open position.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a Continuation of and claims priority to U.S.patent application Ser. No. 14/930,595, entitled “Clips and Applicatorfor Tissue Closure,” which claims priority to U.S. Provisional PatentApplication No. 62/074,212, filed Nov. 3, 2014, entitled “BioabsorbableClips and Applicator for Tissue Closure,” the entire disclosures ofwhich are hereby incorporated by reference in their entirety.

This invention was made with government support under TR000128 awardedby the National Institutes of Health. The government has certain rightsin the invention.

TECHNICAL FIELD

Embodiments herein relate to surgical clips and surgical clipapplicators used in tissue closure.

BACKGROUND

The brain and spine are covered with a tough outer membrane called thedura mater, or dura. During surgical procedures, e.g., spinal surgery,the dura mater may be opened intentionally or inadvertently. Such anopening is called a durotomy or dural tear. Dural tears requiringclosure or repair have been reported to occur in a significantpercentage of surgical procedures. In some approaches, sutures are usedto repair or close the dura. Durotomies must be closed prior to closingthe skin. Failure of the closure can result in persistent cerebrospinalfluid (CSF) leakage, for example. This leakage may result in woundbreakdown, spinal headaches, infection, meningitis, and otherconsequences.

Minimally invasive surgeries (MIS) are becoming more commonly usedduring surgical procedures, e.g., to treat a variety of pathologiesincluding herniated discs, spinal stenosis, synovial cysts,spondylolisthesis, deformity, intradural tumors, etc. Such proceduresuse smaller incisions to decrease intraoperative blood loss, reducetissue disruption, decrease postoperative pain, and decrease lengths ofhospital stays, for example.

Minimally invasive surgeries make use of smaller ports and result inless tissue disruption than traditional procedures. However, should adurotomy occur using a minimally invasive surgery, closure of the duracan become extremely difficult or impossible due to the small size ofthe incision. For example, in the setting of minimally invasive spinesurgery, the ability to close a durotomy may be compromised when suturematerial cannot be manipulated sufficiently to achieve tight closure.Thus, due to the physical limitations of small working areas, repair ofa durotomy may be technically difficult and time-consuming when usingconventional suture and knot-tying techniques.

In order to overcome these technical difficulties resulting fromminimally invasive surgeries, metal staples, such as titanium staples,delivered via a suitable applicator may be crimped or bent from an openposition into a closed position around the tissue edges to close a holein a tissue such as a durotomy. However, in such approaches, it isnecessary to place the staples sufficiently close together along a duratear in order to close the tissue since such staples may be too thin tocover and hold significant lengths along the tissue break. Further, useof metal staples or clips either results in a permanent foreign bodyleft in the tissue or a second surgical intervention to remove thestaples or clips. Clips or staples left in the tissue may interfere withpostoperative imaging resulting in undesirable artifacts in radiographicimaging such as magnetic resonance imaging (MRI) and computed tomography(CT) scans.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments will be readily understood by the following detaileddescription in conjunction with the accompanying drawings and theappended claims. Embodiments are illustrated by way of example and notby way of limitation in the figures of the accompanying drawings.

FIG. 1 shows an illustration of a surgical applicator applying examplesurgical clips to close a durotomy in accordance with variousembodiments.

FIGS. 2-23 show scaled drawings of example surgical clips and examplesurgical clip applicators in accordance with various embodiments.

DETAILED DESCRIPTION OF DISCLOSED EMBODIMENTS

In the following detailed description, reference is made to theaccompanying drawings which form a part hereof, and in which are shownby way of illustration embodiments that may be practiced. It is to beunderstood that other embodiments may be utilized and structural orlogical changes may be made without departing from the scope. Therefore,the following detailed description is not to be taken in a limitingsense.

Various operations may be described as multiple discrete operations inturn, in a manner that may be helpful in understanding embodiments;however, the order of description should not be construed to imply thatthese operations are order-dependent.

The description may use perspective-based descriptions such as up/down,back/front, and top/bottom. Such descriptions are merely used tofacilitate the discussion and are not intended to restrict theapplication of disclosed embodiments.

The terms “coupled” and “connected,” along with their derivatives, maybe used. It should be understood that these terms are not intended assynonyms for each other. Rather, in particular embodiments, “connected”may be used to indicate that two or more elements are in direct physicalcontact with each other. “Coupled” may mean that two or more elementsare in direct physical contact. However, “coupled” may also mean thattwo or more elements are not in direct contact with each other, but yetstill cooperate or interact with each other.

For the purposes of the description, a phrase in the form “A/B” or inthe form “A and/or B” means (A), (B), or (A and B). For the purposes ofthe description, a phrase in the form “at least one of A, B, and C”means (A), (B), (C), (A and B), (A and C), (B and C), or (A, B and C).For the purposes of the description, a phrase in the form “(A)B” means(B) or (AB) that is, A is an optional element.

The description may use the terms “embodiment” or “embodiments,” whichmay each refer to one or more of the same or different embodiments.Furthermore, the terms “comprising,” “including,” “having,” and thelike, as used with respect to embodiments, are synonymous, and aregenerally intended as “open” terms (e.g., the term “including” should beinterpreted as “including but not limited to,” the term “having” shouldbe interpreted as “having at least,” the term “includes” should beinterpreted as “includes but is not limited to,” etc.).

With respect to the use of any plural and/or singular terms herein,those having skill in the art can translate from the plural to thesingular and/or from the singular to the plural as is appropriate to thecontext and/or application. The various singular/plural permutations maybe expressly set forth herein for sake of clarity.

The present disclosure is directed to surgical clips and surgicalapplicators that may be used in performing rapid tissue closure ineither minimally invasive surgeries or traditional open procedures. Inparticular, the surgical clips described herein are intended for use inclosing durotomies, particularly durotomies resulting from minimallyinvasive surgeries.

A surgical applicator may be used to deliver the clips down a smallopening, thereby obviating the need for sutures and knot tying to closethe durotomy. An array of stacked surgical clips may be loaded intoinwardly-turned tracks in a chamber or reservoir of the surgicalapplicator. A force may be applied to push a clip in the tracks towardsa tip of the surgical applicator. The sides of that clip may be heldwithin tracks at the tip of the applicator such that the mouth of theclip opens around the everted tissue edges of the dura, for example.Upon release of the clip from the applicator, the clip may grasp theeverted edges, pulling the edges towards one another, closing theopening in the tissue. A force may again be applied to the next clip inthe array so that the next clip is pushed into position to be opened atthe mouth of the applicator for a subsequent application.

Disclosed herein is a surgical clip that includes opposing sidesextending from a top portion. Each of the opposing sides may be convex.The opposing sides terminate at tips positioned below the top portion.The resting position of the clip is its closed position, and in theclosed position, the tips are set at a first distance apart. Edges ofthe top portion and the first and second opposing sides form opposingfront and back faces perpendicular to the first and second opposingsides. The front and back faces are angled inwardly towards each otherat a region of the faces adjacent to the top portion. A first groove isformed in the first side. The first groove extends from the front faceto the back face and has a top inner surface formed by a bottom surfaceof a region of the top portion extending over the first side. A secondgroove is formed in the second side. The second groove extends from thefront face to the back face. The second groove has a top inner surfaceformed by a bottom surface of a region of the top portion extending overthe second side. The first groove is substantially parallel to thesecond groove and the first and second grooves are substantiallyperpendicular to the front and back faces at a region of the front andback faces adjacent to the first and second tips. The first and secondgrooves are each configured to engage inwardly turned tracks at an endof a clip applicator such that, when a force is applied to the clip, thefirst and second sides bend outwardly away from each other, therebyincreasing the distance between the tips to a second distance betweenthe tips to place the clip in an open position. In the open position,the distance between the tips is greater than the distance between thetips in the closed position. In some embodiments, the width of the clipmay be least 25% of the length of the clip (length is the dimension fromthe end of the first side to the end of the second side, while width isthe dimension of the clip perpendicular to the length). In someembodiments, each tip may be made up of at least two tabs. Each tab mayconverge in a direction towards the opposing tip to form two opposingpairs of teeth. In some embodiments, the first and second grooves may beeach configured to engage inwardly turned tracks at an end of a clipapplicator such that when a push rod of the clip applicator is used toapply pressure to the top portion, the first and second sides bendoutwardly away from each other, thereby increasing the distance betweenthe tips to the second distance between the tips. In alternativeembodiments, the first and second grooves may be each configured toengage inwardly turned tracks of a clip applicator, where a distancebetween the inwardly turned tracks decreases at an end of the clipapplicator, such that when a force is applied to the back face of theclip, the clip moves within the tracks toward the end of the clipapplicator thereby increasing the distance between the tips to thesecond distance between the tips.

Disclosed herein is an array of surgical clips. The array comprises twoor more of the clips described above and a chamber housing the array ofclips. The chamber has inwardly turned tracks engaging the grooves ofeach clip to maintain the front and back faces of each clip asorientated in the same direction as the front and back faces of theother clips in the plurality of surgical clips, yet large enough toallow movement of the plurality of clips in the direction of the facesof the clips. The clips in the array can also be in physical contactwith one another. In some examples, a direction of the inwardly turnedtracks may transition from a vertical direction to a horizontaldirection in a transition region of the tracks and the angled regions ofthe faces of adjacent clips in the transition region may interface witheach other.

Disclosed herein is a surgical clip applicator. The applicator includesa clip array within a chamber as described above and a pushing elementconfigured to apply pressure to a top clip in the array. The applicatorcan also have a grating in a front wall or a back wall of the chamber.The grating may extend from the transition region of the tracks in adirection away from an open end of the chamber to hold the tracks inplace and permit a user to view the clips in the applicator.

Since everted tissue edges are grasped by the surgical clip in such anapproach, a risk of adhesion to the underlying spinal cord may bepotentially reduced. Further, by applying a force to open such asurgical clip from a closed, resting state to an intermediate open stateand then releasing the force to permit the clip to close to its restingstate around the dural tissues, a greater amount of control may beconferred to the final closed state of the clip around the tissues toprovide pressure on the dura leaflets for maintaining closure of thedurotomy.

In this way, closure of the dura using a small bioabsorbable clip tograsp but not penetrate the tissue edges and maintain tension until thetissues heal may be applied quickly, easily, and in rapid succession byusing an applicator. Such an approach may potentially increase speed andease of clip application, decrease the risk of CSF leakage, decreaseintradural adhesions due to non-penetration of the clip, reduce risk ofadhesion to the underlying spinal cord, minimize dural exposure, anddecrease expensive operative time. Further, such an approach may also beused in other surgical arenas where reapproximation is desired;including, for example, cranial surgery for closure of the dura, generalsurgery for closure of hollow organs, urologic surgery for closure ofthe bladder, closure of uereters and other tubular structures, andgynecological procedures for closure of reproductive structures.

The following description relates to bioabsorbable surgical clips andsurgical applicators for performing rapid watertight tissue closure inminimally invasive or traditional open procedures. For example, asillustrated in FIG. 1 , a surgical applicator 116 may be used to deliverone or more surgical clips, e.g., clips 118, to assist in tissueclosure. In FIG. 1 , a dural tear or durotomy 108 is shown in the duramater 104 around a spinal cord 106. As remarked above, the dura mater isa tough outer membrane covering the brain and spinal cord which may beopened intentionally or inadvertently during surgical procedures.

The surgical clips may be composed of any material including anysuitable bioabsorbable or resorbable material. The terms bioabsorbableand resorbable are used herein to mean dissolving inside the human bodyafter a period of time. In some examples, the bioabsorbable material maybe chosen based on a time duration at which the material dissolves. Forexample, the bioabsorbable material may have the property that it doesnot substantially dissolve within seven days after installation alongthe tissue but dissolves any time after one week while maintainingstructural integrity before then. For example, the bioabsorbablematerial may comprise a biocompatible, bioabsorbable polymer such asPoly-L-Lactic Acid/Poly glycolic acid (PLLA/PGA), Polycapralactone,Polydioxanone or some combination thereof. By using a bioabsorbablematerial, no permanent foreign body is left in the tissue followingsurgery. Further in some examples, the clip may be composed of amaterial that is radiolucent, e.g., invisible or transparent to x-rays,as well as bioabsorbable. For example, the surgical clips may becomposed of a suitable material which is radiolucent and bioabsorbableso that substantially no undesirable artifacts from the clips appear inradiographic imaging e.g., in magnetic resonance imaging (MRI) andcomputed tomography scans (CT). Further, by using a bioabsorbable andradiolucent material, surgical clips with a wide footprint may be usedto cover a greater length along the tissue thereby potentiallydecreasing a number of clips needed to reliably seal the tissue in awater tight fashion. Additionally, in some examples, the clips may becomposed of materials, e.g., polymers, selected to achieve apredetermined amount of strength, flexibility, and/or other mechanicalproperties of the clip.

As illustrated in FIG. 1 at 124, a surgical clip used to close adurotomy may comprise a first side 132 and a second side 130, where thesecond side 130 opposes the first side 132. The first and secondopposing sides 132 and 130 extend from a top portion 128 of the clip andterminate at first and second tips positioned below the top portion 128.For example, the first side 132 is coupled to and extends from topportion 128 and terminates at a first tip 134 positioned below the topportion 128. Likewise, the second side 130 is coupled to and extendsfrom top portion 128 and terminates at a second tip 136 positioned belowthe top portion 128. In an installed, closed position, the tips 134 and136 of the surgical clip may grasp but not penetrate or pierce evertedtissue edges. For example, in FIG. 1 surgical clip 114 is shown in aninstalled position along the durotomy 108 grasping everted tissue edges112 and 110. The surgical clips may include a variety of features andmay have a variety of shapes and dimensions, examples of which aredescribed below with reference to the scaled drawings of FIGS. 2-23 . Insome embodiments, the clip may have a length in a range from 3-5millimeters (mm), a height in a range of 3-5 mm, a width in a range of3-5 mm, and a diameter (if cylindrically shaped) in a range of 3-5 mm.In some examples, the top portion 128 of the clip may include anaperture 138, slots, and/or other features used to achieve a particularbending moment of the surgical clip. For example, as described in moredetail below, sides of the surgical clip may be temporarily bent outwardby applying a force to the clip while holding the sides in place toinstall the clip over everted tissue edges. In some examples, a size ofa slot or aperture or a thickness of the top portion of the clip may beselected so that the clip confers an optimal amount of force to graspthe tissue while maintaining the ability to be temporarily opened viaengagement with tracks of the surgical applicator during an installationof the clip. For example, the clip may be designed to withstand at least10 cmH₂O pressure (e.g., prostrate pressure) without leakage and may, insome examples, be designed to withstand 20 cmH₂O (e.g., standing lumbarpressure) without leakage. Further, the material selected may be basedon a desired elasticity for applying a predetermined holding force tothe tissue for a predetermined duration following installation of theclip around everted tissue edges.

The clip may include features that are configured to engage with thesurgical applicator to assist in installation of the clip around edgesof a tissue break. For example, the surgical clip may include grooves,cut-outs, notches, tabs or other suitable features that engage tracks orprotrusions of the surgical applicator, e.g., which engage protrusions122 and 123 of surgical applicator 116 shown in FIG. 1 . The exampleclips shown in FIG. 1 include tabs extending outwardly from the firstand second sides of the clip. For example, a tab 140 is shown extendingoutwardly from first side 132 and may be configured to engage withprotrusion 123 of the applicator 116 and tab 142 is shown extendingoutwardly from second side 130 and may be configured to engageprotrusion 122 of the applicator. However, in other examples, such tabsmay be omitted or other alternative engagement features may be includedon the opposing sides of the clip, examples of which are shown in FIGS.2-23 described below.

As illustrated in FIG. 1 , a stack of surgical clips 118 may be loadedinto the surgical applicator 116 for quick successive delivery ofsurgical clips to grasp everted tissue edges, e.g., the bent andinterfacing tissue edges 112 and 110, to close the durotomy. Forexample, as shown in FIG. 1 , an installed surgical clip 114 grasps butdoes not penetrate or pierce the everted edges of the dura therebyholding the edges together. Surgical applicator 116 may be used todeliver the clips down a small opening during minimally invasiveprocedures thereby potentially obviating the need for sutures and knottying to close the dura. In one example approach, an array of stackedsurgical clips 118 may be loaded into a chamber or reservoir of thesurgical applicator and a downward force from a push rod or otherpushing element in the chamber may be used to push the center of a cliplocated at a tip of the surgical applicator, e.g., clip 120 shown inFIG. 1 , while the sides of that clip are firmly held at the tip causingthe mouth of the clip to open around the everted tissue edges 110 and112 of the dura. To release the clip, the push rod or pushing elementmay be retracted allowing the clip to grasp and reapproximate the twodural edges 110 and 112. The push rod or pushing element can thenretract further to engage the next clip in the reservoir so that thenext clip is pushed into position to be opened at the mouth of theapplicator for a subsequent application to the everted tissue edges. Itshould be understood that the use of a push rod to eject the clip isprovided by way of illustration and any other suitable pusher or ejectorfeature may be included in the clip applicator. Further, the term “pushrod” as used herein may refer to any such suitable pusher or ejectorfeature of the applicator used to deploy the clips. In alternativeembodiments, examples of which are described below with regard to FIGS.2-23 , an array of clips may be loaded into inwardly turned trackswithin a clip applicator and a force may be applied to a top clip in thearray of clips to push the clips around a bend in the tracks. A distancebetween the tracks may decrease at an end of the applicator such thatwhen a clip is pushed toward the end of the applicator within thetracks, the clip is forced into a temporary open position until itdisengages with the tracks and returns to its closed, resting position.

The surgical clips have a closed resting configuration which can besubstantially the same before and after installation along the tissueedges. During installation with the surgical applicator, the surgicalclips have an intermediate open state formed by engagement of the clipwith features of the surgical applicator during the installation of theclip. By applying a force to the clip while sides of the clip areengaged with features of the surgical applicator, a reversibledeformation of the clip from a closed resting position to anintermediate open position may occur. This deformation is recoverableonce the clip disengages with the engagement features of the applicatorafter the clip is positioned around the tissue edges so that the clipreturns to its closed resting position to grasp the everted edges.

FIG. 1 shows an example clip in a closed resting state at 124 and in theintermediate open state at 126. In the closed resting state there is afirst distance 146 between the first and second tips 134 and 136. Inthis closed position, the first distance may be selected so as toprovide a sufficient amount of space between the tips 134 and 136 toaccommodate a thickness of the everted tissue edges to which it is to beapplied (e.g., enough space to accommodate twice the thickness of thedura) while maintaining sufficient gripping force on the everted tissueedges after application. The first side 132 and the second side 130 ofthe clip are configured to engage the clip applicator such that, whenthe clip applicator is used to apply a pressure to the clip, the firstand second sides bend outwardly away from each other thereby increasingthe distance between the tips to a second distance 148 greater than thefirst distance 146 so that the clip is temporarily deformed to an openposition for installation around the tissue edges. In some examples,this second distance 148 may be a predetermined distance, e.g., at least3 mm, achieved via forces applied to the clip from the clip applicator.

By applying a force to open such a surgical clip from a closed, restingstate to an intermediate open state and then releasing the force topermit the clip to again close to its resting state around the duraltissues, a greater amount of control may be conferred to the finalclosed state of the clip around the tissues to provide an optimalpressure on the dura leaflets for maintaining closure. For example, thegrasping force of the closed resting state of such a clip may betailored to a specific type or thickness of tissue to which it is to beapplied.

FIGS. 2-23 described below show scaled drawings of various exampleembodiments of surgical clips and surgical clip applicators. The examplenumerical dimensions shown in these figures are in millimeters (mm).Further, like-numbered elements used throughout the figures correspondto like elements.

Turning to FIGS. 2-4 , a first example embodiment of a surgicalapplicator 116 and surgical clip 114 is shown from various perspectivesand cross-sections. At 206, 208, 210, and 212, various viewpoints of thefirst example embodiment of a surgical clip 114 are shown. Inparticular, a front face view of example clip 114 is shown at 206, aside view of clip 114 is shown at 208, a bottom view of clip 114 isshown at 210, and a perspective view of clip 114 is shown at 212.

Clip 114 comprises a concave top portion 128 with opposing sides 130 and132 extending therefrom. In particular, a first side 132 is coupled totop portion 128 via a rounded junction 251 and curves inwardly fromjunction 251 to a tip 134 positioned below top portion 128. Likewise, asecond side 130 is coupled to top portion 128 via a rounded junction 252and curves inwardly from junction 252 to a tip 136 positioned below topportion 128. A thickness of each tip of the opposing tips 136 and 134tapers or decreases in a direction toward the opposing tip so that eachtip of the opposing tips 136 and 134 converges in a direction towardsthe opposing tip. The concave top portion 128 curves toward the interiorof the clip in the center of the top portion so that a minimum height ofthe clip occurs at the center of the top portion. The opposing sides 130and 132 and the rounded junctions 251 and 252 coupling the sides 132 and130 to the top portion form a heart-shaped face as seen in view 206.

In this example, each of the first and second opposing sides 132 and 130of the clip comprises a flat portion coupled via a curved top junctionto the top portion 128. For example, flat portion 249 is included inside 130 and flat portion 245 is included in side 132. Flat portion 249may be parallel with flat portion 245 when the clip is in the closedposition.

Edges of the top portion 128 and the first and second opposing sides,132 and 130, form opposing front and back faces 271 and 273,respectively, perpendicular to the first and second opposing sides. Asshown at 208, the front face 271 and back face 273 are angled inwardlytowards each other at a region of the faces adjacent to the top portion128. In this example, the region 275 of the front face adjacent to thetop portion 128 is inwardly angled by approximately 15 degrees relativeto the region 276 of the front face adjacent to the first and secondtips. Likewise, the region 277 of the back face adjacent to the topportion is inwardly angled by approximately 15 degrees relative to theregion 278 of the back face adjacent to the first and second tips.

Each of the first and second tips 134 and 136 converges in a directiontowards the opposing tip to form two opposing pairs of teeth. Forexample, tip 134 comprises a first tooth 260 and a second tooth 262 andtip 136 comprises a first tooth 259 and a second tooth 261. Each toothof a tip converges in thickness and width to an edge facing an opposingtooth on the other tip. For example, a width and thickness of tooth 260on tip 134 decreases in a direction toward the opposing tooth 259 on tip136 and a width and thickness of tooth 262 on tip 134 decreases in adirection toward the opposing tooth 261 on tip 136. Teeth 259 and 261 ontip 136 likewise converge to the opposing teeth on tip 134 so that anaperture 263 is formed in the bottom of the clip between teeth of thetips. In some examples, this aperture 263 may have a circular shape witha predetermined diameter, e.g., a diameter of 2.5 mm. In alternativeexamples, as shown at 210, aperture 263 may have a rounded rectangularshape. It should be understood that the aperture formed between theteeth of the tips on the bottom of the clip may have any suitablediameter or shape, e.g., oval-shaped, rectangular, diamond-shaped, etc.The teeth may be used to hold everted edges of tissue in place whilenot-penetrating and not piercing the tissue when repairing a durotomy,for example. One of skill in the art in light of this disclosure wouldunderstand how to make tips 134 and 136 of sufficient sharpness to graspbut not penetrate or pierce everted edges of a tissue such as a durawithout undue experimentation.

Each of the first and second sides 132 and 130 includes a groove ornotch configured to engage tracks in surgical applicator 116. Inparticular, a first groove 291 is formed in the first side 132. Thefirst groove 291 extends from the front face 271 to the back face 273.The first groove has a top inner surface 293 formed by a bottom surfaceof a region of the top portion 128 extending over the first side 132.Likewise, a second groove 292 is formed in the second side 130. Thesecond groove 292 extends from the front face 271 to the back face 273.The second groove 292 has a top inner surface 295 formed by a bottomsurface of a region of the top portion extending over the second side130. The first groove 291 is substantially parallel to the second groove292 and the first and second grooves are substantially perpendicular tothe front and back faces at a region of the front and back facesadjacent to the first and second tips, e.g., regions 276 and 278.

The first and second grooves, 291 and 292, are each configured to engageinwardly turned tracks 296 and 297 of a clip applicator 116 such that,when a force is applied to the clip, the first and second sides bendoutwardly away from each other, thereby increasing the distance betweenthe tips to a second distance between the tips, wherein the seconddistance between the tips is greater than the first distance between thetips, thereby placing the clip in an open position.

The example clip 114 has a height 254 extending in a direction from amidpoint of the opposing tips 134 and 136 towards the top portion 128, alength 253 extending in a direction from first side 132 towards secondside 130, and a width 299 extending from the front face 271 of the cliptowards the back face 273 of the clip in a direction perpendicular tolength 253. In this example, the height 254 is less than the length 253and the height is substantially the same as the width 299. For example,the length may be approximately 5 mm and the height and width may bothbe approximately 3 mm; however, it should be understood that thesedimensions are provided by way of example and are not intended to belimiting. Any suitable height, length, and width may be used.

The surgical clip 114 is shown in views 206, 208, 210, and 212 in aclosed resting position with a first distance 146 between opposing tips134 and 136. For example, this first distance 146 between the tips maybe approximately 0.05 mm when the clip is in its resting closed state. Alength of this first distance 146 may be based on a type and thicknessof tissue to which it is to be applied. For example, the first distance146 may be greater for applications on a thicker tissue.

Though not shown in FIG. 2 , in some examples, the top portion 128 maybe substantially flat when the clip is in the resting state (e.g., asshown in FIG. 1 ), but may become concave or temporarily bent inwardduring a transitional intermediate open state of the clip duringinstallation of the clip using clip applicator 116. In particular,tracks 296 and 297 of clip applicator 116 may engage grooves 291 and 292of clip 114 so that clip 114 is moveable within the tracks. A force maybe applied to the clip to move the clip in the tracks towards the distalend 247 of the surgical applicator. In some examples, while the groovesare engaged with the tracks at the distal end 247, a force may beapplied to the top portion of the clip so that the distance between thetips of the clip increases to a second distance greater than the firstdistance 146, e.g., greater than 0.05 mm, so that the tips of the clipare opened for installation of the clip around everted tissue edges.This second distance may be a distance of at least a predeterminedamount, e.g., at least 3 mm. Alternatively, as described below, a forcemay be applied to the back face 273 of the clip to move the clip withinthe tracks towards the distal end 247 of the surgical applicator. Inthis example, a distance between the tracks may decrease at the distalend 247 of the applicator 116 so that when the clip is forced toward thedistal end, the clip is at least partially placed into the openposition.

Various views and cross-sections of an example surgical applicator areshown at 202, 204, 302, 304, 306, 308, 310, 312, and 314 in FIGS. 2-3 .In particular, at 202, a perspective view of example surgical clipapplicator 116 is shown. At 204, a detailed view is shown of a distalend 247 of the applicator 116 in the region A shown in view 202. Theview 204 is shown at a scale of 4:1 relative to the view shown at 202.At 308 a front view of applicator 116 is shown. At 310, a cross-sectionof applicator 116 is shown along section B-B shown in view 308. View 302shows a detailed view of section C shown in view 310, where view 302 isshown at a scale of 3:1 relative to view 310. View 312 shows a side viewof applicator 116. View 314 shows a cross-sectional view alongcross-section D-D in view 312. View 306 shows a detailed view of regionE shown in view 314 and is shown at a scale of 3:1 relative to view 314.View 304 shows a perspective view of applicator 116.

With reference to views 202, 204, 302, 304, 306, 308, 310, 312, and 314shown in FIGS. 2-3 , the surgical applicator 116 comprises an elongatedbody 341 defining a chamber with an open end 247 within which a push rod343 is contained. The push rod 343 extends away from the open end 247 ofthe surgical clip applicator and terminates at a thumb pusher element350. The thumb pusher element 350 comprises a curved handle shaped tofit a thumb of a user. The clip applicator further includes two opposingfinger grasping elements 348 and 349 coupled to the elongated body 341.For example, a user may grip the finger grasping elements 348 and 349with two fingers and apply a downward force to the thumb pusher element350 to urge the push rod downward toward the distal end 247 in order toapply a force to one or more clips in the chamber of the applicator.

Different sizes of the applicator may be available depending on aquantity of clips desired (e.g., an applicator may house 5-30 clips).For example, the applicator may come in different lengths depending onthe type of surgery to be performed and the tissue on which the surgerywill be performed. A short handle applicator may be used for opensurgeries while a longer handle applicator may be used for deeper,smaller portals generated by minimally invasive surgical procedures. Forexample a height 342 of the applicator 116 may be in a range of 125-150mm (˜5-6 inches) for minimally invasive procedures. The applicator maybe used by right or left-handed neurosurgeons and may utilize activationmechanisms that are standard or familiar to neurosurgeons. For example,the activation mechanism of the applicator may utilize a pistol gripdesign, a syringe plunger-type design, a looped-end forcep design, etc.Further, the applicator may be activated by fingers of a user ratherthan whole-hand activation for increased dexterity and fine motorcontrol.

An array or stack of surgical clips 318 is included within a chamber orreservoir within the walls of the elongated body 341 of the applicator.The chamber has inwardly turned rails or tracks 296 and 297 engaging thegrooves of each clip to maintain the front and back faces of each clipas orientated in the same direction as the front and back faces of otherclips in the plurality of surgical clips, yet large enough to allowmovement of the plurality of clips in the direction of the faces of theclips. For example, the stack of surgical clips 318 may comprise two ormore clips in physical contact with one another. A direction of theinwardly turned tracks transitions from a vertical direction to ahorizontal direction in a bend or transition region 391 of the tracks.In the transition region 391, the angled regions of the faces, e.g.,angled regions 275 and 277 shown at 208, of adjacent clips in thetransition region interface with each other. For example, as shown at302, the angled portion of the back face of clip 331 physically touchesthe angled portion of the front face of adjacent clip 333 in thetransition region 391. The angled portions of the clips permit the clipsto be stacked while they transition from a vertical to a horizontaldirection around a bend or transition region of a surgical applicator.This allows the clips to be stacked but then dispensed individually andmay accommodate flexure of the clips as a force is applied to dispensethe clips.

In some examples, the array of stacked clips may be loaded into thechamber of the surgical applicator as a group rather than individually.For example, a user may obtain a package of a predetermined number ofpre-stacked and pre-aligned surgical clips, e.g., including five or moreindividual clips stacked face to face with each other and oriented inthe same direction, and may load this package of clips into the tracksof the surgical applicator, e.g., via an entry point comprising anopening at a top end of the applicator. As another example, an array ofsurgical clips may be preloaded into the applicator so that an end userreceives a fully assembled pre-packaged applicator including apre-loaded quantity of clips loaded within the chamber. Such apre-packaged surgical clip applicator may have any suitable number ofclips contained therein, e.g., 5, 10, 15, or 30 clips per applicator.The number of clips included in an applicator may depend on a particularsurgical application. For example, the number of clips included in aclip array may depend on a particular surgical application or a lengthof the tissue tear to which the clips are to be applied. Such apre-packaged, pre-loaded surgical clip applicator may be sterilized andsuitably wrapped and, in some examples, may be disposable after use andmay include labeling which indicates various parameters associated withthe surgical applicator and clips therein such as dimensionalinformation, disclaimer information, clip material composition, etc.

The array of stacked clips includes a top clip 337 which is in contactwith a spring-loaded pusher element 381 in contact with the back face oftop clip 337. A spring 382 interfaces with pusher element 381 in theclip applicator to apply a continuous downward pressure to the stack ofclips in the applicator. In particular, the spring-loaded pusher element381 biases the stack of clips 318 toward the distal end 247 of theapplicator 116.

The array of stacked clips also includes a bottom clip 383 at the distalend 247 of applicator 116. The front face of the bottom clip 383interfaces with stopper elements 384 and 385, which prevent the bottomclip from moving in a direction perpendicular to the front and backfaces of the bottom clip towards the front face of the bottom clip. Anend of the push rod 343 opposing the thumb pushing element 350 is incontact with the top portion of bottom clip 383. The bottom clip 383 maybe held in position via engagement of the grooves or notches in thesides of the clip with the opposing tracks or rails 297 and 296 at thedistal end 247 of the applicator.

In this example embodiment, the push rod 343 interfaces with a topportion of bottom clip 383 via a clip interfacing element 345 coupled toan end of the push rod 343 opposing the thumb pusher element 350. Theclip interfacing element 345 may comprise a cylindrically-shaped elementhaving a radius that complements the curvature of the concave topportion of the clip. Further, in this example, a spring 346 is includedaround a portion of the push rod between the thumb pusher element 350and an inner wall feature within the chamber of the applicator. Thespring 346 can comprise a wire spring encircling a portion of the pushrod 343 which provides a biasing force to the push rod 343 in adirection away from the distal end 247 in order to return the push rodto an initial retracted position following an application of a downwardforce to the push rod via the thumb pushing element. However, in otherexamples, such a spring element may be omitted.

The surgical applicator 116 may also include grippers 371 at the distalend 247. Grippers 371 may comprise two opposing arms which are biasedaway from each other but are held in a closed position around the sidesof bottom clip 383 when opposing circular tabs 372 extending from pushrod 343 interface with outer surfaces of the grippers. In particular thetabs 372 hold the grippers 371 together for an initial duration while adownward force is applied via push rod 343 to the top portion of bottomclip 383 to open the clip. After the initial duration wherein the clip383 is opened, application of the downward force via the push rod to thetop portion of bottom clip 383 may be continued so that the tabs 272 arepushed into opposing aperture or holes 373 formed in opposing sides ofbody 341. The apertures 373 have diameters larger than the diameters ofthe circular tabs 372 so that when the tabs are moved into theapertures, constraint of the grippers by the tabs is released so thatthe opposing arms of the grippers move away from each other therebyreleasing the clip from the distal end of the surgical applicator sothat the open clip can be installed around everted tissues edges.

In some examples, a cover 340 may be included along a portion of atleast one wall of the chamber of the surgical applicator. The cover 340may comprise at least a portion of a wall of the applicator chamberperpendicular to side walls 338 and 339 of the chamber. In someexamples, cover 340 may be composed of a transparent material. The covermay extend a distance along a wall of the chamber from above the tabs372 toward the thumb pusher element to terminate at a location adjacentto spring 346. Cover 340 may be removable and may be used to assist inassembly of the applicator.

In some examples, applicator 116 may also include a grating 393 in awall of the chamber housing the clips. The grating may extend along thetracks 297 and 296 and may comprise a plurality of parallel trusses,ribs, or support members where each truss, rib, or support member spansfrom one track to the opposing track to provide support to the opposingtracks 296 and 297.

FIG. 4 shows various viewpoints and cross-sections of an examplesurgical clip applicator system 402 which comprises a tubular retractor497 within which clip applicator 116 may be inserted while performing asurgical procedure on dura 104. At 406, a top view of the surgical clipapplicator system is shown. At 408, a side view of the surgical clipapplicator system is shown. At 412, a detailed view of an end of thetubular retractor 497 is shown for the region F shown in view 408. At410, a perspective view of the surgical clip applicator system with theapplicator inserted into the tubular retractor 497 at an angle is shown.At 416, a side view of the surgical clip applicator system with theapplicator inserted into the tubular retractor 497 at an angle 490 isshown. View 414 shows a detailed view of the region G shown in view 416.

Tubular retractor 497 may comprise a cylindrical body 483 defining aninner working aperture 481 extending from a top lip 480 to an open end498 at the surgical site. The top lip extends around a circumference ofthe working aperture at a top open end of the tubular retractor 497opposing the open end 498 and a circumference of the top lip may begreater than a circumference of the cylindrical body. For example, theinner working aperture may have a diameter of approximately 25 mm andmay have a height 496 of approximately 80 mm so that applicator 116 caneasily fit within the tubular retractor during a surgical procedure.

The tubular retractor 497 may further include a supporting element 482coupled to the lip 480 at an end of the tubular retractor 497 opposingend 498. For example, during a surgical procedure, the tubular retractor497 may be positioned via supporting element 482 so that end 498encompasses a surgical working area over the tissues to be repaired. Inorder to close the tissue using the clip applicator, the applicator 116may be inserted into the tubular retractor 497 so that the distal end247 of the applicator extends beyond end 498 of the tubular retractor497 toward the tissue tear so that a surgical clip may be applied toeverted tissue edges along the tear.

As shown in view 416 the applicator may be tilted away from a centralaxis of the tubular retractor 497 so that an angle 490 is formed betweena central axis of the applicator and a central axis of the tubularretractor 497, e.g., a 5° angle. In this way a clip may be applied usingthe applicator without obstructing the view of the surgeon applying theclips to the tissues.

Turning to FIGS. 5-8 , another example embodiment of a surgicalapplicator 116 and surgical clip 114 are shown from various perspectivesand cross-sections. At 506, 508, 510, and 512 various viewpoints of thesecond example embodiment of a surgical clip 114 are shown. Inparticular, a front face view of an example clip 114 is shown at 506, aside view of clip 114 is shown at 508, a bottom view of clip 114 isshown at 510, and a perspective view of clip 114 is shown at 512. Thetop portion 128 of the surgical clip shown in FIGS. 5-6 comprises twoopposing wings, 581 and 582, which extend over the opposing sides 132and 130. The grooves 291 and 292 are formed between top inner surfacesof the wings of the top portion and shelves 593 and 595 formed in eachside. In particular, groove 291 has top inner surface 293 formed by abottom surface of a region or wing 581 of the top portion 128 extendingover the first side 132 and a bottom inner surface 593 formed as a topsurface or shelf within side 132. Likewise, groove 292 has top innersurface 295 formed by a bottom surface of a region or wing 582 of thetop portion 128 extending over the second side 130 and a bottom innersurface 595 formed as a top surface or shelf within side 130. In thisexample, the angle between the top inner surface 293 and the bottominner surface 593 and the angle between the top inner surface 295 andthe bottom inner surface 595 are both 60 degrees. However, in otherexamples, the angle between the top inner surfaces and the bottom innersurfaces of the grooves may be greater than 60 degrees or less than 60degrees, e.g., 25 degrees. Further, when the clip is in the closedposition, the bottom inner surface 593 may lie in the same plane asbottom inner surface 595.

FIG. 6 shows additional embodiments of example surgical clips in theclosed resting position in views 602, 604, 606, and 608 and in anintermediate open position in views 610 and 612. Additionally, in view614 a stack of surgical clips 318 is shown. The stack of surgical clipscomprises a top clip 337 having a back face 273 which is not in physicalcontact with another clip and a bottom clip 383 having a front facewhich is not in contact with another clip. In the stack 318, the facesof adjacent clips may be in physical contact with each other and thestacking of the clips may accommodate a transition region 391 where theorientation of the clips transitions from a vertical direction to ahorizontal direction. In the transition region 391, the angled regionsof the faces, e.g., angled regions 275 and 277 shown at 508, of adjacentclips in the transition region interface with or physically touch eachother.

Various views and cross-sections of example surgical applicator areshown at 502, 504, 702, 706, 708, 710, 712, and 714 in FIGS. 5 and 7 .In particular, at 502, a perspective view of example surgical clipapplicator 116 is shown. At 504, a detailed view is shown of a distalend 247 of the applicator 116 in the region A shown in view 502. Theview 504 is shown at a scale of 4:1 relative to the view shown at 502.At 708 a front view of applicator 116 is shown. At 710, a cross-sectionof applicator 116 is shown along section B-B shown in view 708. View 702shows a detailed view of section C shown in view 710, where view 702 isshown at a scale of 3:1 relative to view 710. View 712 shows a side viewof applicator 116. View 714 shows a cross-sectional view alongcross-section D-D in view 712. View 706 shows a detailed view of regionE shown in view 714 and is shown at a scale of 3:1 relative to view 714.

The surgical applicator shown in FIGS. 5 and 7 in similar to theapplicator shown in FIGS. 2-3 described above. However, in this examplethe clip interfacing element 345 comprises a wedge-shaped componentwhich tapers in a direction toward distal end 247. The clip interfacingelement has a rounded end which can interface with the concave topportion 128 of the clip when a downward force is applied to push rod343. Further, in this example, a spring 346 is included around a portionof the push rod at a location adjacent to the clip interfacing element345. As remarked above, the spring 346 can comprise a wire springencircling a portion of the push rod 343 which provides a biasing forceto the push rod 343 in a direction away from the distal end 247 in orderto return the push rod to an initial retracted position following anapplication of a downward force to the push rod via the thumb pushingelement. However, in other examples, such a spring element may beomitted.

Additionally, in the example shown in FIGS. 5 and 7 , the grippers 371are held in a compressed position by opposing tabs 372 extending fromthe distal end of the push rod 343. Each tab in the opposing tabs 372extends through a cut-out or aperture, e.g., apertures 373, in the armsof gripper 371 and is upwardly bent to interface with an outer surfaceof an arm of the gripper above the cutout to hold the grippers 371 inthe compressed position so that the inwardly turned tracks hold thebottom clip 383 in place at the distal end 247 of the applicator. Inparticular, the tabs 372 hold the grippers 371 together for an initialduration while a downward force is applied via push rod 343 to the topportion of bottom clip 383 to open the clip. After the initial durationwherein the clip 383 is opened, application of the downward force viathe push rod to the top portion of bottom clip 383 may be continued sothat the tabs 272 are pushed into opposing apertures or cutouts 373formed in opposing sides of body 341. The apertures 373 are larger thanthe tabs 372 so that when the tabs are moved into the apertures,constraint of the grippers by the tabs is released so that the opposingarms of the grippers move away from each other thereby releasing theclip from the distal end of the surgical applicator so that the openclip can be installed around everted tissues edges.

FIG. 8 shows various viewpoints and cross-sections of another examplesurgical clip applicator system 402 which utilizes the clip applicatorand clips shown in FIGS. 5-7 described above. The embodiments shown inFIG. 8 are similar to the embodiments shown in FIG. 4 described above.In particular, at 806 a top view of the surgical clip applicator systemis shown. At 808, a side view of the surgical clip applicator system isshown. At 812, a detailed view of an end of the tubular retractor 497 isshown for the region F shown in view 808. At 810, a perspective view ofthe surgical clip applicator system with the applicator inserted intothe tubular retractor 497 at an angle is shown. At 816, a side view ofthe surgical clip applicator system with the applicator inserted intothe tubular retractor 497 at an angle 490 is shown. View 814 shows adetailed view of the region G shown in view 816.

Turning to FIGS. 9-10 , another example embodiment of a surgicalapplicator 116 and surgical clip 114 are shown from various perspectivesand cross-sections. At 906, 908, 910, and 912 various viewpoints of asurgical clip 114 are shown. In particular, a front face view of anexample clip 114 is shown at 906, a side view of clip 114 is shown at908, a bottom view of clip 114 is shown at 910, and a perspective viewof clip 114 is shown at 912. The surgical clip shown in FIG. 9 issimilar to the surgical clip shown in FIG. 5 described above. Inparticular, the top portion 128 of the surgical clip comprises twoopposing wings, 581 and 582, which are angled relative to each other andextend above and outward over the opposing sides 130 and 132. Further,in this example, the angled regions 275 and 277 in the faces 271 and 273are formed in a region of the faces above the shelves 593 and 595.Additionally, in this non-limiting example, the concave top portion 128is inwardly curved with a radius of 0.45 mm.

Various views and cross-sections of the surgical applicator are shown at902, 904, 1002, 1006, 1008, 1010, 1012, and 1014 in FIGS. 9 and 10 . Inparticular, at 902, a perspective view of example surgical clipapplicator 116 is shown. At 904, a detailed view is shown of a distalend 247 of the applicator 116 in the region A shown in view 902. Theview 904 is shown at a scale of 4:1 relative to the view shown at 902.At 1008 a front view of applicator 116 is shown. At 1010, across-section of applicator 116 is shown along section B-B shown in view1008. View 1002 shows a detailed view of section C shown in view 1010,where view 1002 is shown at a scale of 3:1 relative to view 1010. View1012 shows a side view of applicator 116. View 1014 shows across-sectional view along cross-section D-D in view 1012. View 1006shows a detailed view of region E shown in view 1014 and is shown at ascale of 3:1 relative to view 1014.

The surgical applicator shown in FIGS. 9 and 10 is similar to theapplicator shown in FIGS. 5 and 7 described above. However, in thisexample the opposing tabs 372 do not extend beyond the arms of grippers371 but instead extend from a distal end of the push rod 343 to remainbetween the arms of the grippers in the interior of body 341. In thisexample, the grippers are formed as an extension of body 341 and remaincompressed around the bottom clip to hold the clip in position at thedistal end 247 of the applicator. When a downward force is applied tothe push rod 343, the tabs interface with internal downwardly-angledshelves 991 and 993 to transfer outward forces to the arms of thegrippers 371 so that the bottom clip is released from the inwardlyturned tracks 296 and 297.

FIG. 11 shows various viewpoints and cross-sections of another examplesurgical clip applicator system 402 which utilizes the clip applicatorand clips shown in FIGS. 9 and 10 described above. FIG. 11 is similar toFIGS. 4 and 8 described above. In particular, at 1106 a top view of thesurgical clip applicator system is shown. At 1108, a side view of thesurgical clip applicator system is shown. At 1112, a detailed view of anend of the tubular retractor 497 is shown for the region F shown in view1108. At 1110, a perspective view of the surgical clip applicator systemwith the applicator inserted into the tubular retractor 497 at an angleis shown. At 1116, a side view of the surgical clip applicator systemwith the applicator inserted into the tubular retractor 497 at an angle490 is shown. View 1114 shows a detailed view of the region G shown inview 1116.

Turning to FIGS. 12-15 , other example embodiments of a surgicalapplicator 116 and surgical clip 114 are shown from various perspectivesand cross-sections. At 1206, 1208, 1210, 1212, 1306, 1308, 1310, 1312,1314, 1316, 1318, 1320, 1322, 1324, 1406, 1408, 1410, 1412, and 1413various viewpoints of example embodiments of a surgical clip 114 areshown. In particular, a front face view of an example clip 114 is shownat 1206, a side view of clip 114 is shown at 1208, a bottom view of clip114 is shown at 1210, and a perspective view of clip 114 is shown at1212. The surgical clip shown in FIG. 12 is similar to the surgical clipshown in FIG. 9 described above. However, in this example the wings 581and 582 extend a non-zero distance beyond the sides 132 and 130 so thatthe length 253 of the top portion is greater than a length 1223 betweenthe outer surface of side 132 and the outer surface of side 130.Further, in this example, the angle between the top inner surface 293and the bottom inner surface 593 and the angle between the top innersurface 295 and the bottom inner surface 595 are both 25 degrees.Additionally, the grooves 291 and 292 in the clip shown in FIG. 12include an inner flat region positioned between the top inner surface ofthe top portion, e.g., 293 and 295, and the shelves 593 and 595.Further, in this example, the angled regions 275 and 277 in the faces271 and 273 are formed in a region of the faces extending below theshelves 593 and 595.

In some examples, as shown in FIGS. 13 and 14 , each of the first andsecond tips 134 and 136 may converge to form staggered teeth. Forexample, tip 134 may converge in a direction towards tip 136 to form twoteeth positioned adjacent to the two opposing faces and tip 136 mayconverge in a direction towards tip 134 to form a single tooth locatedbetween the two teeth formed by tip 134. In views 1406, 1408, and 1410in FIG. 14 , exemplary dimensions, angles, and tolerances of a surgicalclip are shown in accordance with the disclosure. The dimensions shownin FIG. 14 are in millimeters.

Various views and cross-sections of the fourth example surgicalapplicator are shown at 1216, 1218, 1220, 1502, 1504, 1506, 1508, 1510,and 1520 in FIGS. 12 and 15 . In some examples, the example surgicalapplicator shown in FIGS. 12 and 15 may be attached adjacent to a distalend of an applicator body such as body 341 described in the examplesabove. In particular, the applicator shown in FIGS. 12 and 15 mayinclude additional components, such as push rods, chambers, biasingcomponents, etc. not shown in FIGS. 12 and 15 . Views 1216, 1218, and1220 show various perspective views of the example applicator. Views1502, 1508, and 1510 show side views of the applicator and views 1506,1504, and 1520 show front views of the applicator.

The surgical applicator shown in FIGS. 12 and 15 includes a chamber 1505housing a plurality of surgical clips. The chamber 1505 has inwardlyturned tracks 296 and 297 for engaging the grooves of each clip tomaintain the front and back faces of each clip as orientated in the samedirection as the front and back faces of the other clips in theplurality of surgical clips, yet large enough to allow movement of theplurality of clips in the direction of the faces of the clips. Adirection of the inwardly turned tracks transitions from a verticaldirection to a horizontal direction in a transition region 391 of thetracks. In the transition region 391, the angled regions of the faces ofadjacent clips in the transition region interface with or touch eachother. Additionally, a distance between the inwardly turned tracksdecreases at an end of the applicator 247. In this example, theapplicator includes a grating 393 in a front wall of the chamberopposing the clip array. The grating 393 extends from the transitionregion of the tracks in a direction away from the open end of thechamber.

FIG. 16 shows various viewpoints and cross-sections of another examplesurgical clip applicator system 402 which utilizes the clip applicatorand clips shown in FIGS. 12-15 described above. In particular, at 1606 atop view of the surgical clip applicator system is shown. At 1608, aside view of the surgical clip applicator system is shown. At 1612, adetailed view of an end of the tubular retractor 497 is shown for theregion F shown in view 1608. At 1610, a perspective view of the surgicalclip applicator system with the applicator inserted into the tubularretractor 497 at an angle is shown. At 1616, a side view of the surgicalclip applicator system with the applicator inserted into the tubularretractor 497 at an angle 490 is shown. View 1614 shows a detailed viewof the region G shown in view 1616.

FIGS. 17-20 show another example clip applicator which is similar to theapplicator shown in FIGS. 12 and 15 described above. However, in thisexample, the applicator include a supporting element 1703 coupledbetween a bottom support member 1793 of the grating 393 and a front face1791 of the applicator where the inwardly turned tracks, 296 and 297,terminate at the distal end 247. An aperture 1781 may be formed in thecenter of the supporting member 1703. For example, a push rod may beinserted through the aperture 1781 so that a force can be applied to thetop portion of the bottom clip to release the clip from the applicator.The supporting member may increase stability of the applicator.

Turning to FIGS. 21-22 , other example embodiments of a surgicalapplicator 116 and surgical clip 114 are shown from various perspectivesand cross-sections. The examples shown in FIGS. 21-22 are similar to theexamples shown in FIG. 12 and FIG. 17 described above. However, in thisexample, the transition region 391 has a greater radius to assist themovement of clips within the tracks around the transition region. FIG.23 shows various viewpoints and cross-sections of another examplesurgical clip applicator system 402 which utilizes the clip applicatorand clips shown in FIGS. 21 and 22 described above.

The following claims particularly point out certain combinations andsubcombinations regarded as novel and nonobvious. These claims may referto “an” element or “a first” element or the equivalent thereof. Suchclaims should be understood to include incorporation of one or more suchelements, neither requiring nor excluding two or more such elements.Other combinations and subcombinations of the disclosed features,functions, elements, and/or properties may be claimed through amendmentof the present claims or through presentation of new claims in this or arelated application. Such claims, whether broader, narrower, equal, ordifferent in scope to the original claims, also are regarded as includedwithin the subject matter of the present disclosure.

Although certain embodiments have been illustrated and described herein,it will be appreciated by those of ordinary skill in the art that a widevariety of alternate and/or equivalent embodiments or implementationscalculated to achieve the same purposes may be substituted for theembodiments shown and described without departing from the scope. Thosewith skill in the art will readily appreciate that embodiments may beimplemented in a very wide variety of ways. This application is intendedto cover any adaptations or variations of the embodiments discussedherein. Therefore, it is manifestly intended that embodiments be limitedonly by the claims and the equivalents thereof.

What is claimed is:
 1. A surgical clip and clip applicator system,comprising: at least one clip comprising: first and second opposingsides extending from a top portion, wherein the first and secondopposing sides terminate at first and second tips positioned below thetop portion with a first distance between the first and second tips,thereby placing the clip in a closed resting position; edges of the topportion and the first and second opposing sides forming opposing frontand back faces at least substantially perpendicular to the first andsecond opposing sides; a first groove formed in the first side, thefirst groove extending from the front face to the back face, the firstgroove having a top inner surface formed by a bottom surface of a regionof the top portion extending over the first side; and a second grooveformed in the second side, the second groove extending from the frontface to the back face, the second groove having a top inner surfaceformed by a bottom surface of a region of the top portion extending overthe second side, where the first groove is substantially parallel to thesecond groove and wherein the first and second grooves are substantiallyperpendicular to the front and back faces at a region of the front andback faces adjacent to the first and second tips; and a clip applicatorhaving inwardly turned tracks at an end of the clip applicator; whereinthe first and second grooves are each configured to engage the inwardlyturned tracks of the clip applicator such that, when a force is appliedto the clip, the first and second sides bend outwardly away from eachother, thereby increasing the distance between the tips to a seconddistance between the tips, wherein the second distance between the tipsis greater than the first distance between the tips, thereby placing theclip in an open position; and wherein the clip returns to its closedresting position when the force is released.
 2. The system of claim 1,wherein the first and second grooves are each configured to engageinwardly turned tracks at the end of the clip applicator such that whena push rod of the clip applicator is used to apply pressure to the topportion, the first and second sides bend outwardly away from each other,thereby increasing the distance between the tips to the second distancebetween the tips.
 3. The system of claim 1, wherein the first and secondgrooves are each configured to engage inwardly turned tracks of the clipapplicator, where a distance between the inwardly turned tracksdecreases at an end of the clip applicator, such that when a force isapplied to the top portion of the clip, the clip moves within the trackstoward the end of the clip applicator thereby increasing the distancebetween the tips to the second distance between the tips.
 4. The systemof claim 1, wherein the region of the front face adjacent to the topportion is inwardly angled by approximately 15 degrees relative to theregion of the front face adjacent to the first and second tips, andwherein the region of the back face adjacent to the top portion isinwardly angled by approximately 15 degrees relative to the region ofthe back face adjacent to the first and second tips.
 5. The system ofclaim 1, wherein a bottom inner surface of the first groove forms anangle of approximately 25 degrees relative to the top inner surface ofthe first groove and wherein a bottom inner surface of the second grooveforms an angle of approximately 25 degrees relative to the top innersurface of the second groove.
 6. The system of claim 5, wherein an innerflat region is formed between the bottom inner surface and the top innersurface of the first groove and the inner flat region is perpendicularto the bottom inner surface of the first groove, and wherein an innerflat region is formed between the bottom inner surface and the top innersurface of the second groove and the inner flat region is perpendicularto the bottom inner surface of the second groove.
 7. The system of claim1, wherein the region of the top portion extending over the first sideforms two opposing wings extending a non-zero distance beyond the firstand second sides so that a length of the top portion is greater than alength between an outer surface of the first side and an outer surfaceof the second side.
 8. The system of claim 1, wherein a width of theclip is greater than at least 25% of a length of the clip, wherein thelength of the clip is the dimension from the first side to the secondside and the width of the clip is the dimension perpendicular to thelength.
 9. The system of claim 1, wherein the first tip converges in adirection toward the second tip to form two teeth positioned adjacent tothe two opposing faces and the second tip converges in a directiontoward the first tip to form a single tooth located between the twoteeth formed by the first tip.
 10. The system of claim 1, wherein thecenter of the top portion is concave.
 11. The system of claim 1, whereinthe top portion is concave, wherein a top surface of the top portionabove the first side forms a first angle with a top surface of the topportion above the second side in the closed resting position, andwherein the top surface of the top portion above the first side forms asecond angle with the top surface of the top portion above the secondside in the open position, where the first angle is greater than thesecond angle.
 12. The system of claim 1, wherein the top portion isconcave, wherein a top surface of the top portion above the first sideforms a first angle with a top surface of the top portion above thesecond side in the closed resting position, and wherein the top surfaceof the top portion above the first side forms a second angle with thetop surface of the top portion above the second side in the openposition, where the first angle is greater than the second angle,wherein the first angle is greater than 90 degrees and the second angleis less than 90 degrees.
 13. The system of claim 1, wherein at least alower portion of each of the first and second opposing sides is convex.14. The system of claim 1, wherein the clip is composed of abioabsorbable material.
 15. The system of claim 1, wherein the clip iscomposed of a radiolucent material.
 16. The system of claim 1, whereineach of the first and second opposing sides comprises a flat portioncoupled via an inner top junction to the top portion and coupled via acurved bottom junction to the tip.
 17. The system of claim 1,comprising: a surgical clip array including a plurality of the clips;and the clip applicator having a chamber for housing the surgical cliparray of clips; wherein the plurality of clips comprises two or moreclips in physical contact with one another.
 18. The system of claim 1,comprising: a surgical clip array including a plurality of the clips;the front and back faces of each clip being angled inwardly towards eachother at a region of the faces adjacent to the top portion; wherein adirection of the inwardly turned tracks transitions from a verticaldirection to a horizontal direction in a transition region of the tracksand wherein the angled regions of the faces of adjacent clips in thetransition region interface with each other.
 19. The system of claim 1,further comprising a surgical clip array including a plurality of theclips including a top clip, wherein the back face of the top clipinterfaces with a push rod of the clip applicator.
 20. The system ofclaim 1, comprising: a surgical clip array including a plurality of theclips; the surgical clip array positioned within a chamber at the end ofthe clip applicator; and a push rod configured to apply pressure on atop clip of the surgical clip array.
 21. The system of claim 1, asurgical clip array including a plurality of the clips, the inwardlyturned tracks engaging the grooves of each clip to maintain the frontand back faces of each clip as orientated in the same direction as thefront and back faces of the other clips in the plurality of clips, yetlarge enough to allow movement of the plurality of clips in thedirection of the faces of the clips.
 22. The system of claim 1, whereinthe front and back faces are angled inwardly towards each other at aregion of the faces adjacent to the top portion.
 23. The system of claim1, the first distance of the closed resting position is designed toaccommodate a thickness of everted tissue edges to which the clip is tobe applied while maintaining sufficient gripping force thereon.
 24. Thesystem of claim 1, wherein said open position is an intermediate openposition.
 25. The system of claim 1, said at least one clip beingrecoverable from deformation.
 26. The system of claim 1, said at leastone clip being temporarily deformable.
 27. The system of claim 1,wherein said open position is a non-resting position.
 28. A surgicalclip and clip applicator system, comprising: at least one clipcomprising: first and second opposing sides extending from a topportion, wherein the first and second opposing sides terminate at firstand second tips positioned below the top portion with a first distancebetween the first and second tips, thereby placing the clip in a closedresting position; edges of the top portion and the first and secondopposing sides forming opposing front and back faces at leastsubstantially perpendicular to the first and second opposing sides; afirst groove formed in the first side, the first groove extending fromthe front face to the back face, the first groove having a top innersurface formed by a bottom surface of a region of the top portionextending over the first side; and a second groove formed in the secondside, the second groove extending from the front face to the back face,the second groove having a top inner surface formed by a bottom surfaceof a region of the top portion extending over the second side, where thefirst groove is substantially parallel to the second groove and whereinthe first and second grooves are substantially perpendicular to thefront and back faces at a region of the front and back faces adjacent tothe first and second tips; wherein a width of the clip is greater thanat least 25% of a length of the clip, wherein the length of the clip isthe dimension from the first side to the second side and the width ofthe clip is the dimension perpendicular to the length; and a clipapplicator having inwardly turned tracks at an end of the clipapplicator; wherein the first and second grooves are each configured toengage the inwardly turned tracks of the clip applicator such that, whena force is applied to the clip, the first and second sides bendoutwardly away from each other, thereby increasing the distance betweenthe tips to a second distance between the tips, wherein the seconddistance between the tips is greater than the first distance between thetips, thereby placing the clip in an open position.
 29. A surgical clipand clip applicator system, comprising: at least one clip comprising:first and second opposing sides extending from a top portion, whereinthe first and second opposing sides terminate at first and second tipspositioned below the top portion with a first distance between the firstand second tips, thereby placing the clip in a closed resting position;edges of the top portion and the first and second opposing sides formingopposing front and back faces at least substantially perpendicular tothe first and second opposing sides; a first groove formed in the firstside, the first groove extending from the front face to the back face,the first groove having a top inner surface formed by a bottom surfaceof a region of the top portion extending over the first side; whereinthe first tip converges in a direction toward the second tip to form twoteeth positioned adjacent to the two opposing faces and the second tipconverges in a direction toward the first tip to form a single toothlocated between the two teeth formed by the first tip; and a secondgroove formed in the second side, the second groove extending from thefront face to the back face, the second groove having a top innersurface formed by a bottom surface of a region of the top portionextending over the second side, where the first groove is substantiallyparallel to the second groove and wherein the first and second groovesare substantially perpendicular to the front and back faces at a regionof the front and back faces adjacent to the first and second tips; and aclip applicator having inwardly turned tracks at an end of the clipapplicator; wherein the first and second grooves are each configured toengage the inwardly turned tracks of the clip applicator such that, whena force is applied to the clip, the first and second sides bendoutwardly away from each other, thereby increasing the distance betweenthe tips to a second distance between the tips, wherein the seconddistance between the tips is greater than the first distance between thetips, thereby placing the clip in an open position.
 30. A surgical clipand clip applicator system, comprising: at least one clip comprising:first and second opposing sides extending from a top portion, whereinthe first and second opposing sides terminate at first and second tipspositioned below the top portion with a first distance between the firstand second tips, thereby placing the clip in a closed resting position;edges of the top portion and the first and second opposing sides formingopposing front and back faces at least substantially perpendicular tothe first and second opposing sides; a first groove formed in the firstside, the first groove extending from the front face to the back face,the first groove having a top inner surface formed by a bottom surfaceof a region of the top portion extending over the first side; and asecond groove formed in the second side, the second groove extendingfrom the front face to the back face, the second groove having a topinner surface formed by a bottom surface of a region of the top portionextending over the second side, where the first groove is substantiallyparallel to the second groove and wherein the first and second groovesare substantially perpendicular to the front and back faces at a regionof the front and back faces adjacent to the first and second tips; asurgical clip array including a plurality of the clips; and a clipapplicator having inwardly turned tracks at an end of the clipapplicator; the clip applicator having a chamber for housing thesurgical clip array of clips; wherein the first and second grooves areeach configured to engage the inwardly turned tracks of the clipapplicator such that, when a force is applied to the clip, the first andsecond sides bend outwardly away from each other, thereby increasing thedistance between the tips to a second distance between the tips, whereinthe second distance between the tips is greater than the first distancebetween the tips, thereby placing the clip in an open position; andwherein the plurality of clips comprises two or more clips in physicalcontact with one another.